Summary

How the insane asylum became a laboratory of democracy is revealed in this provocative look at the treatment of the mentally ill in nineteenth-century France. Political thinkers reasoned that if government was to rest in the hands of individuals, then measures should be taken to understand the deepest reaches of the self, including the state of madness. Marcel Gauchet and Gladys Swain maintain that the asylum originally embodied the revolutionary hope of curing all the insane by saving the glimmer of sanity left in them. Their analysis of why this utopian vision failed ultimately constitutes both a powerful argument for liberalism and a direct challenge to Michel Foucault's indictment of liberal institutions.

The creation of an artificial environment was meant to encourage the mentally ill to live as social beings, in conditions that resembled as much as possible those prevailing in real life. The asylum was therefore the first instance of a modern utopian community in which a scientifically designed environment was supposed to achieve complete control over the minds of a whole category of human beings. Gauchet and Swain argue that the social domination of the inner self, far from being the hidden truth of emancipation, represented the failure of its overly optimistic beginnings.

Madness and Democracy combines rich details of nineteenth-century asylum life with reflections on the crucial role of subjectivity and difference within modernism. Its final achievement is to show that the lessons learned from the failure of the asylum led to the rise of psychoanalysis, an endeavor focused on individual care and on the cooperation between psychiatrist and patient. By linking the rise of liberalism to a chapter in the history of psychiatry, Gauchet and Swain offer a fascinating reassessment of political modernity.

Author Notes

Marcel Gauchet is the editor of Le Débat and the author of The Disenchantment of the World (Princeton). Gladys Swain was a practicing psychiatrist and the author of Dialogue avec l'insensé (Gallimard).

Publisher's Weekly Review

Gauchet and Swain challenge Foucault's classic analysis in Madness and Civilization that the "great confinement" of the insane represented the psychiatrization of political and social deviants, and that asylum treatment simply tried to inculcate bourgeois values. Instead of a history of subjugation, their analysis of late 18th- and early 19th-century French psychiatry shows how the modern self came to be understood as a complex creature with dangerous, irrational depths. Gauchet and Swain acknowledge the liberal, humanitarian intentions of "alienists" and cast the psychiatric exercise of power as beneficent in intent although no less insidious than Foucault portrayed it. Dr. Philippe Pinel's famous "moral therapy" and the expansion of the asylum system after the French Revolution, they argue, were a product of therapeutic optimism, driven by the conviction that the insane were never so bestial or alienated from their humanity as to be deaf to the voice of reason or self-reflection. This new model of the insane, in turn, prompted the modern understanding of the self. Furthermore, they contend, the asylum system was structured as an ideal community that crystallized the totalitarian exercise of power in postrevolutionary democratic society. Like Foucault, however, they are given to convoluted philosophical language and sweeping generalizations about subjectivity, power and society that are untethered by documentary supports but sure to stimulate much theoretical speculation. (June) (c) Copyright PWxyz, LLC. All rights reserved

Choice Review

Gauchet, editor of Le Debat, France's influential intellectual journal, and Swain, until her death in 1993 a psychiatrist and historian of psychiatry, collaborated in 1980 on this fertile interpretation on the history of the idea of insanity and on political efforts to cure the insane. The translation reflects the original French's highly complex tone, and thanks to the lucid and suggestive foreword, the patient reader can make headway into this important but difficult work. The origins of modern psychiatric care grew out of the idealistic efforts of Philippe Pinel, who pioneered humane treatment of the mentally ill during the French Revolution, with his plan to cure insanity through wholesome therapeutic conditions. When Pinel failed, optimistic liberals demanded greater efforts and resources, ultimately leading to modern psychiatric medicine. Contrary to Foucault (see his Madness and Civilization, CH, Dec'65), Gauchet and Swain argue that the desire to cure the insane by institutionalized medicalization stemmed from liberalism's compassion, rather than lack of it. Paradoxically, this sensitivity empowers the democratic state to oversee and control its citizenry in the name of sanity. As much philosophy as cultural history, this work deserves a thoughtful audience, especially readers interested in the relationship between history of psychiatry and modern society. Graduate, faculty. D. R. Skopp; SUNY College at Plattsburgh